Paediatric upper limb injuries and conditions

Supracondylar fractures are a common upper extremity fracture. The peak age is between 5-7 after falling on an outstretched hand. Mostly 98% are extension type fractures, and this extension can cause stretch, or injury to the adjacent nerves and vessels.

This injury is one of emergent treatment and often done in a closed reduction and K wire fixation, and open if wires on the medial aspect.

following this fracture stiffness may occur and occasional deformity if the bone fails to heal in the correct position. 

Supracondylar fractures are very common and are well managed.

This is the most common fracture for children. Often the fracture involves the growth plate or physis. These are best treated with prompt reduction to a near anatomic position and held in that position either with a cast or pins or occasionally plates.

The treatment time frame depends on the injury and the age, often between 4-6 weeks in a cast and then active movements to restore function. Children often recover quickly without the need for physiotherapy, but guidance can be given with videos available from this website or playing games encouraging range of motion, such as clapping games and dance moves.

Occasionally fracture that involve the growth plate may cause a change to the growth of the bone, and this may need to be addressed to prevent ongoing wrist or elbow issues.

This is a congenital condition of the failure of decent of the scapular. Embryologically the scapular starts high in the neck and descends intrauterine in the first trimester. failure of this leads to a high, often smaller, protracted scapula and weak periscapular muscles. There are other conditions associated with this condition such as spinal changes, in the neck or thoracic spine. 

The management for this condition aims at maintaining function or improving the limited function with operative intervention. 

Instability, shoulder dislocations or subluxations are common conditions that involves more and more teenagers as the increased sporting uptake. Instability may cause pain, neurologic compromise and loss of function and eventual arthritis if failure to achieve adequate stability.

Dislocations at an early age to increase the likelihood of recurrent instability and long term issues. This should be addressed with physiotherapy, appropriate investigations and actions to improve stability of the shoulder. This may include activity modification, physiotherapy and surgery.